utumn is believed to be the best time in Beijing, when the city enjoys the biggest number of blue skies of the year and is embellished with golden ginkgo leaves. However, for Wu Peng, a Beijing resident, autumn is the hardest time, so hard that he wants nothing more than to flee the city.
That is because Wu suffers a runny nose every fall thanks to his allergic rhinitis. When the sky clears and he feels the autumn winds, Wu feels awful – he coughs heavily, often sneezes, his watery eyes itch and turn red. He cannot even sleep at night – his nose constantly runs onto his pillow if he lies on his belly, but the catarrh blocks his throat if he lies on his back. His suffering is not eased until it starts to rain.
Wu’s suffering began two years ago. He thought he was catching a bad cold, but his doctor later confirmed that he suffers from allergic rhinitis caused by the pollen from wormwood, a plant that commonly grows in Beijing’s downtown and suburban areas. According to Chinese doctors, about 10 percent of the Chinese population suffers from allergies, with the allergens varying according to the season and the location. Yet, despite the fast growth in the number of sufferers, China’s study and treatment of allergies lags far behind.
For help, Wu turned to Beijing Tongren Hospital (BTH), a key hospital for curing and studying allergies. It has seen a growing number of allergy sufferers since it set up a special department in 2007. By lunch break on the typical day when NewsChina came to interview allergy specialist Doctor Wang Xiangdong, he was still inundated with patients who had appointments in the morning session, and the waiting room was already packed with those booked for the afternoon.
According to a study by Zhang Luo, BTH’s deputy president and director of the Allergy Society under the Chinese Medical Association (CMA), the number of Chinese allergy sufferers has risen to 150 million, nearly 10 percent of China’s total population. Wu said that whenever he complained on WeChat, China’s main messaging app, about his allergies and his suffering, many of his friends complained they were affected too. Wang Lianglu, deputy director of the allergy department of Peking Union Medical College Hospital (PUMCH), China’s leading hospital for allergy study and treatment, told NewsChina that 20 years ago, he only saw 10 to 20 patients in a half-day session, but now, he sees 30 or 40 in the same amount of time, even though the hospital has taken measures to control the number of appointments. In 2009, PUMCH treated around 70,000 allergy sufferers, the number of which soared by around 43 percent to 100,000 in 2017.
It indicates that suffering from allergies, reportedly the world’s sixth largest disease, is affecting more and more people in China. “Allergic reactions have become a new epidemic disease in the new era,” warned Yin Jia, director of PUMCH’s allergy department.
Yin has been leading a team of specialists from 18 provincial hospitals to investigate allergies nationwide since 2008, although time constraints mean they have yet to deliver any findings.
Nevertheless, some smaller studies are strong enough to prove the spread of allergies in China. Three investigations into asthmatic children by Beijing Children’s Hospital under the Capital Medical University conducted from 1990 to 2010 showed that 1.08 percent of Chinese children aged 0-14 suffered from asthma in 1990, but the number rose to 1.97 percent in 2000 and to 3.01 percent in 2010.
BTH’s deputy president Zhang Luo conducted two phone surveys on allergic rhinitis in 2005 and 2011. He found the number of allergic rhinitis sufferers had grown from 11.1 percent to 17.6 percent during the six years.
“In the next decade, the growth in the number of Chinese allergy sufferers might be bigger than that in developed countries, and food and pollen in polluted air will be the two dominant allergens,” Yin told NewsChina.
Xiao Ling, a colleague of Wu’s, has suffered from rhinitis and asthma for 10 years. Although it remains unknown what exactly caused her allergies, she seldom had a reaction after she moved to Hangzhou, a tourism and tech city in Southeast China’s Zhejiang Province, well known for its scenic West Lake.
Moving south may have helped Xiao, but no region is safe from potential allergens, as different regions have different triggers. For example, ragweed is a dominant allergen in the US, while in Europe, many people are allergic to grass pollen. As China is vast, natural allergens vary by region – wormwood and climbing hops are major allergens in the north, and in the south, the top allergen is the plane tree.
“A Beijinger who is sensitive to pollen should not travel west or north in summer and fall where the pollen is even stronger. South is the only choice for them,” Wang Lianglu told NewsChina.
According to Wang Lianglu, imported plants, such as the green ash in the north and the plane trees in the south, are one of the drivers of China’s growing number of allergy sufferers.
A recent example is that as western Shaanxi, Ningxia and Inner Mongolia are planting more Artemisia – a genus of plants that includes wormwood and sagebrush – to resist desertification, they have seen a soaring number of locals infected with allergic rhinitis – so many sufferers that it has been defined as endemic.
Two other major causes of allergy are foodstuffs, especially nuts like peanuts, and antibiotics, which are frequently overused. As early as 1989, British epidemiologist David Strachan pointed out that people who have not been exposed to germs are more vulnerable to allergies. Although it is debatable whether people can develop allergies by keeping themselves too clean, abuse of antibiotics is increasingly believed to be a major cause of allergic reactions.
Some sufferers wonder whether or not allergies are related to inherited genes and could be detected, but experts believe that sensitivity to allergens is not the result of a single defective gene, but rather from a very complicated, inscrutable system. Wu, who has always lived in northern China, does not know why he suddenly developed an allergy to wormwood pollen at the age of 30.
“Once it occurs, you can’t get rid of an allergy. In other words, there’s an ‘allergic system’ hidden in everyone’s body, and an allergy will immediately affect someone if his or her ‘system’ touches some allergen,” Wen Liping, a deputy chief physician at PUMCH wrote in his book, Get Rid of Allergies.
Misdiagnosis of Allergens
The foundation of successful allergy treatment is always pinpointing the source of the allergen, which is a hard nut to crack in China. Due to the misuse of some so-called “advanced” means, such as biological resonance (BR) instruments and the IgG (immunoglobulin G, a major antibody component of serum) tests, Chinese doctors often misidentify what triggers their patients’ allergic reactions.
Imported in 2003 from Germany, BR instruments should have only been used as an auxiliary treatment for allergies, according to the China Food and Drug Administration (CFDA). Yet, in reality, the instruments are often misused to test for allergens by observing whether a sufferer’s “allergic signal” in the body resonates with the tested substances. Although some experts years ago warned that such a “function” lacks a reliable medical basis, many hospitals, especially private ones, turned a blind eye.
PUMCH once treated a 9-year-old girl who was diagnosed by a BR instrument to be sensitive to over 100 food and contact substances. Despite the BR treatment, her allergies worsened. Doctors at PUMCH finally found she was only allergic to dust mites, fungus, cat hair and some pollens.
For several years, the CMA’s allergy society has appealed to the CFDA to revoke the license of BR instruments, but they have never received a positive reply. Yin said that the licenses will in any case expire this year, and she hopes the CFDA will carefully consider their appeal for the instruments to be banned.
Similarly, the IgG test is designed to judge whether someone is intolerant to specific foodstuffs, but many doctors have confused food intolerance with an allergy. “It’s different,” Wang Lianglu explained, “An allergy indicates that someone’s immunologic mechanism overreacts to a substance. Food intolerance has no relation with the immunologic mechanism, but is a kind of dyspepsia due to lack of an enzyme.”
Zhou Wei, an allergy specialist at Peking University Third Hospital (PUTH) treated a six-year-old boy named Guoguo who had undergone an IgG test in another hospital. He was diagnosed as being sensitive to quite a few foods, including wheat and nuts. After one month’s hard fasting – the hospital forbade Guoguo to eat any food made of or containing wheat and nuts, Guoguo’s mother began to doubt the diagnosis. She finally turned to PUTH and found that Guoguo is only allergic to mites and fungus. Delighted by the news, she immediately bought her son a piece of cake to celebrate.
“Many children have been misdiagnosed by IgG tests, and when we told their parents that their children are actually not allergic to any foods, they feel like a criminal being given a pardon,” Zhou said.
“[Misdiagnosing] food allergies in children is cruel. They are not allowed to eat the allergenic food and they may have some psychological problems due to the bans, so we doctors have to be extraordinarily cautious when making such a judgment,” she added.
According to Zhou, an sIgE (allergen-specific immunoglobulin E test) is one useful means to define whether or not someone is allergic to a foodstuff. Unfortunately, many hospitals have replaced it with the IgG tests, leading many children like Guoguo to be given the wrong treatment for a long time.
Obstacles to Treatment
Wu does have a clear idea what has caused his allergic rhinitis, but he still feels reluctant to treat it, since PUMCH is the only hospital in Beijing that can properly treat the disease and Wu said it is difficult to get an appointment.
It is also believed to be a reason why BR instruments and IgG tests are misused – the Chinese government has exercised strict control over allergenic preparations, which are crucial for allergen defining and desensitization treatment.
PUMCH, for example, previously developed an allergenic preparation against allergic rhinitis by extracting the pollen of wormwood in the suburban areas of Beijing. By injecting the allergenic preparation into a sufferer multiple times, the preparation successfully enabled the sufferer to become hypo allergenic to the pollen. It is a typical desensitization treatment, which usually needs one to two years to take effect and three to five years to make a sufferer acquire lifelong immunity to the pollen.
At that time, there were about 30,000 allergy sufferers being treated at PUMCH, and at its peak, 900 hospitals also used the protocol to treat sufferers. However, in 2001, the CFDA suddenly tightened control of the desensitization preparations, and as the treatment was no longer licensed, many patients started suffering from symptoms again.
Although the CFDA later loosened controls on PUMCH’s preparations by encouraging them to apply for a license for a new machine, Wang Lianglu revealed that his hospital cannot afford the huge cost of the application.
Now, PUMCH only holds licenses for nine allergenic preparations, far from enough to satisfy the demand. To fill the huge supply-demand gap, the CFDA allowed other hospitals to use PUMCH’s preparations based on a special application procedure. However, as the procedure is very complicated and other hospitals found it hard to define responsibility if there was a problem when using PUMCH’s preparations, the procedure is now barely used, according to Wang Lianglu.
“We [PUMCH] actually have over 200 preparations which have been clinically used for more than 50 years, but now only nine of them are available. It has heavily hindered the treatment of allergies. In this aspect, our [Chinese] clinical level of allergy treatment is declining. I really regret that,” he said.
Wang Lianglu revealed that the CFDA’s control also hinders the use of a portable EpiPen which gives a quick injection of adrenaline when allergy sufferers go into anaphylactic shock, which can be fatal. “The EpiPen is imported and the CFDA said that it can’t license it before a comparison test with domestic ones. However, China has not yet produced similar products and given the product is for emergency use, it is hard to do the comparison test,” Wang Lianglu said.
Yin attributes the difficulties in allergy treatment to the embarrassing position of the field, as it is not yet defined as an independent sub-discipline in China. Although the knowledge of allergies is included in the national medical training system, the examinations only test knowledge about respiratory medicine, immunology and dermatology. Worse still, China only has two colleges that grant postgraduate degrees in allergy medicine.
According to Wang Lianglu, allergy medicine was highly respected in the 1990s when the government stipulated that any hospital without an allergy department could not be highly ranked. At that time, PUMCH conducted over 40 training courses helping other hospitals set up allergy departments, but most have declined after the government revoked the requirement for unknown reasons.
Now, different Chinese hospitals distribute allergy treatments to different departments, such as pediatrics, gastroenterology, dermatology or ear, nose and throat. “A large number of allergy doctors actually don’t know the field well, with their medical skills varying dramatically,” Wang Lianglu said.
“The pollen allergy we talked about now is actually what PUMCH studied 20 years ago, and I believe it has changed with the times and social development,” he continued. “However, to test pollen and other allergenic substances in the air is a hard mission in China, and with no idea of the exact allergen, we can’t find a way to carry out treatment,” he added.
His words were echoed by Zhou. “There is an epidemic of allergy sufferers in China, and it will continue to spread, but the government and the public still have no clear awareness about it,” she said. “We have no comprehensive and authoritative studies on epidemic allergies, meaning government departments have no data support when trying to work out measures against allergies, such as food labeling,” she added.